Licensed Behavioral Health UM, RN, SW, Counseling, Psychology
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Job Description
Behavioral health utilization management professional supporting Humana members through clinical reviews and care coordination. Remote Louisiana role requiring licensed nursing or behavioral health expertise.
Responsibilities:
- Support coordination, documentation, and communication of medical services and benefit administration determinations
- Interpret behavioral health criteria, policies, and procedures to determine appropriate treatment, care, or services
- Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment
- Exercise independent critical thinking and determine appropriate courses of action
- Follow established guidelines and procedures while working with minimal direction
- Complete medical necessity reviews against criteria such as MCG, ASAM, and InterQual
- Work Tuesday through Saturday, 8:00 AM–5:00 PM Central Time after training and precepting
- Complete Monday through Friday, 8:00 AM–5:00 PM Central Time training
- Travel occasionally to Humana offices for training or meetings as business needs require
Requirements:
- Must meet one of the following licensure requirements with no history of disciplinary action: Licensed Registered Nurse (RN) – Multi-State Compact; or master's degree in a behavioral health-related field with a professional license from the state of Louisiana
- Eligible licenses include LCSW, LMSW, LPC, LMFT, LAC, or Licensed Psychologist
- 3+ years of post-degree clinical experience in direct patient care
- 3+ years of Behavioral Health experience
- Proficient with MS Office
- Proficient navigating multiple systems and platforms
- General technical skills to troubleshoot and resolve issues within a remote environment
- Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information
- Self-provided internet with at least 25 Mbps download and 10 Mbps upload speed
- Flexibility to accommodate an Eastern Time schedule, occasional weekends, and holidays
- Preferred: Behavioral Health UM experience with medical necessity reviews using MCG, ASAM, or InterQual
- Preferred: Managed Care or Medicaid experience
- Preferred: Health plan experience
Benefits:
- Bonus incentive plan based upon company and/or individual performance
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Remote work arrangement
- Minimal travel for office meetings 1–2 times annually as business needs require
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